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General NPI Number Information
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NPI Number | 1376735951
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Entity Type | Organization
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Legal Business Name | DIAMOND MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 6865 PARKDALE PL STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5655
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Country | US
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Telephone | 317-291-1211
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Fax | 317-291-1194
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Provider Business Mailing Address
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Address Line | 6865 PARKDALE PL STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5655
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Country | US
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Telephone | 317-291-1211
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Fax | 317-291-1194
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS CARLA DIONNE WILLIS
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Credential | M.A
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Telephone | 317-291-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01060259A
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License Number State | IN
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